Concussions - more than just a bump on the head

By Sam Cortes, Communications Coordinator

A concussion is a brain injury that can’t be seen on routine X-rays, CT scans, or MRIs. It affects the way a person may think and remember things and can cause a variety of symptoms. According to Brain Injury Canada, there are approximately 400,000 concussions annually in Canada.

Any blow to the head, face, or neck or a blow to the body that jars your head could cause a concussion. In the minutes to days following a concussion, brain cells remain in a vulnerable state. New research emphasizes that the problem may not be the structure of the brain tissue itself, but how the brain is working. The exact length of this change is unclear. During this time, the brain does not function normally on a temporary basis and is more vulnerable to a second head injury.

Concussion signs and symptoms

Although symptoms may not be immediately apparent, it is important to be aware of possible physical, cognitive, and emotional changes when diagnosing a patient. Some typical signs and symptoms include:

Physical
Headache
Pressure in the head
Dizziness
Nausea or vomiting
Blurred vision
Sensitivity to light or sound
Ringing in the ears
Balance problems

Cognitive
Not thinking clearly
Feeling slowed down
Feeling like “in a fog”
Problems concentrating
Memory problems

Emotional
Easily upset or angered
Sadness
Nervous or anxious
Feeling more emotional

Some of the more extreme symptoms after a traumatic event include:
Significant neck pain or tenderness immediately after the injury
Double vision
Seizure or convulsion
Weakness or tingling/burning in arms and legs
Severe or increasing headache
Deteriorating conscious state
Repeated vomiting
Increase in restlessness, agitation or combative behaviour

Symptoms may actually worsen throughout the day of the injury or even the next day, so be sure to emphasize the importance of vigilance to the patient’s caregiver. Fifty per cent of patients experience personality change, irritability, anxiety, and depression after concussion. These neuropsychiatric symptoms are not unique, but part of the natural course following concussion.

Learn more about symptoms and screening of concussions here.

Diagnosing a concussion

There is no single test that can definitively provide a diagnosis of concussion, but you can perform a neurological exam, which includes checking vision, hearing, strength and sensation, balance, coordination, and reflexes. Cognitive tests can also be performed to assess memory, concentration, and ability to recall information. Brain imaging may also be used to determine whether the injury is severe and has caused bleeding or swelling in the skull.

Treating a concussion

General recommendations for concussion recovery include a short period of rest, followed by a gradual return to activity under the supervision of a medical professional. It may also be necessary to seek support from other health professionals like a neurologist, physiotherapist, and/or occupational therapist. Eighty to 90 per cent of people who sustain a concussion will recover in four to six weeks, however a small percentage of people will go on to develop post concussion syndrome. If you are not recovering within a few weeks, you should seek the advice of a healthcare professional with experience treating people with post concussion syndrome.

Prevention

Unfortunately, concussions can not be prevented. What is more important is how we manage them when they occur. Athletes should be removed from play if a concussion is suspected to avoid sustaining a second impact in short succession. Because concussions are an invisible injury, it is important to stay up-to-date on current research and share concussion information – like this pre-season checklist – with others.

Returning to sport and activity is a step-wise process that requires patience, attention, and caution. Each step must take a minimum of one day, but could last longer, depending on the player and their specific situation. Our return to sport concussion guidelines can help you return to sport safely.